The sago’s most dangerous recipe

Guam

By David North

GUAM Governor Joseph Ada, the American medical research estab lishment, and Washington’s National Institutes of Health, are all criticised in a new report on Guam’s mysterious, always fatal, Alzheimer’s-like syndrome, which wastes mind and body before it kills.

The syndrome is not confined to Guam, but the incidence of it there, until quite recently, was much more common than elsewhere in the world. After World War II American physicians noticed the unusually high incidence of two some what similar maladies; one is amyotrophic lateral sclerosis (ALS), and the other is called Parkinsonish dementia. ALS is known in the United States as Lou Gehrig’s disease; Gehrig a remarkable baseball player and the first prominent victim of the disease, died at the age of 37. The syndrome attacks the nervous system, paralyzing the limbs and the mind; it is progressive, irreversible and without

either a cure or a clearly identified cause.

And, because of the high concentration of cases on Guam it became, in effect, a living laboratory for ALS.

The criticism in the article is both pointed and muted, for the report, by writer Terence Monmaney, appeared in the prestigeful but understated New Yorker magazine. The New Yorker , a weekly of comment and fiction, is read by the more literate members of America’s Establishment; it sometimes covers what it regards as serious medical mysteries, but seldom ventures into the Pacific.

Monmaney, in the magazine’s October 29 issue, discusses the decades of research work done on the syndrome, on Guam and elsewhere, and exhaustively describes the evolution of the various theories on the high incidence of ALS in Guam. (About 20 times as many people suffer from it there than one would expect from world wide medical statistics).

The principal theory is that ALS hits, often years to decades later, people who have consumed food made from the fruit of the false sago palm, or cycad seed, to remove its toxic qualities, and then ground up the fruit to make a flour.

One major thread of the theory was that during the Japanese occupation many Chamorros escaped into the forest and, lacking other food, ate more cycad than usual, and may not have had the time to clean the seeds properly. The toxin apparently acts quite slowly, and adversely effects some people exposed to it, but not others. A neurotoxicologist named Peter S. Spencer, a British scien tist, currently is the leading advocate of the cycad theory.

The author’s criticism of the medical research establishment was based on the one-way communication which charac terises much medical and social science research; the scientist extracts infor mation from the victim, but the victim learns little or nothing in the process, and is not helped as he or she struggles with disease.

The criticism of the National Institutes of Health (NIH) was for abandoning its ALS research station on Guam, in 1986, without consulting anyone on Guam about the decision. Since then NIH has restored funding to study the syndrome, and Congressman Ben Blaz (Republican, Guam), in a move not mentioned by the

New Yorker , has sought legislation to reopen the research station.

The criticism of Ada paralleled criticism of the medical researchers, for not openly, and publiclu urging the people of Guam to stop using cycad on the grounds that it is a high likely health hazard.

Monmaney writes that Ada, “a cheerful man with the aquiline good looks like Danny Thomas’s” has an ambiguous policy towards fadang , the traditional food made from cycad seed.

“The Governor’s ... first reaction to Spencer’s recommendation (not to con sume the stuff) was ‘There goes my favorite food!’ Officially, he (Ada) says he was anti -fadang. But then he said, smiling, that he continues to enjoy it. When he goes to fiestas Chamorro women stack fadang tortillas on his plate, and he doesn’t want to disappoint them. ‘lf I see it, I eat it,’ he said. He told me that he was not much concerned about safety because the people who cook for him know how to detoxify cycad seeds. I lost some confi

dence in his biomedical judgement when, as he graciously led me out of his office, he handed me, as a memento of my visit, a cigarette lighter with his name on it.”

The scientists’ interest in solving the mystery relates to a broader problem than the 800 or so cases of these diseases found by NIH on Guam; if they could get a better idea what caused these lingering deaths then they would be in a better position, worldwide, to seek ways to prevent, cure, or modify the impact of ALS and Parkinsonism-dementia. □